St Petersburg Nursing Home, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

SNF1252096 Issued in FL

Legal business name

ST PETERSBURG NURSING HOME, LLC

Doing business as

Jacaranda Manor

Practice address

4250 66TH St N
Kenneth City, FL 33709-4918

Phone

(727) 546-2405

NPI assigned

Oct 31, 2005

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Michelle Burdette

Title

Director of Finance

Phone

(423) 308-1845

Specialties & licenses 1

Addresses

Other names 1

• Jacaranda Manor Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1130716800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1366433385",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4250 66TH ST N",
            "city": "KENNETH CITY",
            "state": "FL",
            "postal_code": "337094918",
            "telephone_number": "727-546-2405"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4250 66TH ST N",
            "city": "KENNETH CITY",
            "state": "FL",
            "postal_code": "337094918",
            "telephone_number": "727-546-2405"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST PETERSBURG NURSING HOME, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-31",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BURDETTE",
        "authorized_official_first_name": "MICHELLE",
        "authorized_official_title_or_position": "DIRECTOR OF FINANCE",
        "authorized_official_telephone_number": "423-308-1845"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "FL",
            "license": "SNF1252096",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Jacaranda Manor",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Skilled Nursing Facility in Kenneth City, FL
• Providers in Kenneth City, FL by specialty
• Skilled Nursing Facility in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.